O diabetes mellitus é uma doença crônica não transmissível que impõe à pessoa mudanças comportamentais para o cuidado e controle da doença, as quais podem ser influenciadas pelo conhecimento, pelas crenças, atitudes, habilidades, pela motivação e pelo apoio social. Mediante esse contexto, o presente estudo objetivou avaliar os resultados de intervenções educativas, a longo prazo, a partir dos resultados de um ensaio clínico que o antecedeu, denominado estudo clínico primário. Trata-se de um estudo quantitativo, longitudinal, de base populacional e desenvolvido em ambulatório de diabetes de um hospital de nível de atenção terciária, em uma população de 116 pessoas com diabetes mellitus tipo 2, no período de janeiro a novembro de 2015. As intervenções educativas abordaram informações sobre a doença e atividades de autocuidado necessárias para o tratamento, por meio de ferramentas visuais e interativas, fundamentadas na Teoria Social Cognitiva, cujo conceito-chave é a crença pessoal sobre a capacidade de executar determinadas tarefas (autoeficácia). No estudo clínico primário, todos os sujeitos participaram das intervenções educativas, e o grupo intervenção se diferenciou pelas intervenções oferecidas ao familiar, por meio de ligações telefônicas, de modo a promover o diálogo sobre os cuidados com a doença. Destaca-se que o familiar foi indicado pelo paciente, como apoio social para o cuidado à doença. A amostra foi caracterizada pelas variáveis sociodemográficas e hábitos de vida, e, nas análises de interesse, incluíram-se variáveis clínicas, o controle glicêmico, as atividades de autocuidado, o conhecimento da doença e a autoeficácia. Os tempos do estudo foram: basal (T0), final das intervenções (T12) e 24 meses após a finalização (T36). O controle glicêmico foi avaliado a cada seis meses (T0, T6, T12, T18, T24, T30 e T36). A comparação entre os grupos controle e intervenção foi por meio do teste de regressão linear de efeitos mistos e ANOVA para medidas repetidas. Os resultados não mostraram diferença entre os grupos (p>0,05) para as variáveis estudadas (pressão arterial, circunferência abdominal, índice de massa corporal, hemoglobina glicada, glicemia plasmática de jejum, atividades de autocuidado, conhecimento sobre a doença e autoeficácia). No entanto, ao comparar os tempos, observaram-se a redução da pressão arterial e da hemoglobina glicada (p<0,05) e o aumento do índice de massa corporal e da circunferência abdominal (p<0,05), em ambos os grupos. Os escores médios do conhecimento e das atividades de autocuidado aumentaram imediatamente após as intervenções (p<0,05) e diminuíram dois anos após, em ambos os grupos do estudo. A análise descritiva mostrou que o escore médio da autoeficácia se manteve no grupo intervenção e se reduziu no controle, após dois anos, ao término das intervenções. Os resultados indicaram que o modelo de intervenções, que incluiu o apoio social familiar, não mostrou diferença entre os grupos no decorrer do tempo, e, mediante análise descritiva, houve melhora da autoeficácia que se manteve após dois anos, no grupo intervenção. As intervenções educativas grupais se apresentaram efetivas na melhora do controle glicêmico e da pressão arterial, dois anos após as intervenções, e para as variáveis conhecimento sobre a doença e atividades de autocuidado, os resultados sugerem a necessidade de reforços educativos, no decorrer do tempo / Diabetes mellitus is a non-communicable chronic disease that requires the person behavioral changes for the care and control of the disease, which may be influenced by knowledge, beliefs, attitudes, skills, motivation and social support. By this context, this study aimed to evaluate the results of educational interventions in the long term, from the results of a clinical trial that preceded it, called primary clinical trial. This is a quantitative study, longitudinal, population-based, developed in a diabetes clinic of a terciaty care attention level hospital, in a population of 116 people with type 2 diabetes mellitus, in the period from January to November 2015. The educational interventions discussed information about the disease and self-care activities necessary for the treatment, by means of visual and interactive tools, based on Social Cognitive Theory, whose key concept is the personal belief about the ability to perform certain tasks (self-efficacy). In the primary clinical trial all subjects participated in the educational interventions, and the intervention group were differentiated by the interventions offered to the family through phone calls, promoting dialogue about the care of the disease. Highlights that the relative was indicated by the patient, such as social support to care for the disease. The sample was characterized by the variables sociodemographic and lifestyle habits, and about analysis of interest, were included clinical, glycemic control, self-care activities, knowledge of the disease, and self-efficacy. The study times were: baseline (T0), the end of interventions (T12) and 24 months after completion (T36). Glycemic control was evaluated every six months (T0, T6, T12, T18, T24, T30 and T36). The comparison between the control and intervention groups was through the linear regression mixed effects and ANOVA for repeated measures. The results showed no difference between groups (p> 0.05) for the variables that were studied (blood pressure, waist circumference, body mass index, glycated hemoglobin, fasting plasma glucose, self-care activities, knowledge about the disease and self-efficacy). However, when comparing the times, it was possible to observe reduction in blood pressure and reduction of the glycated hemoglobin (p <0.05), increased body mass index and waist circumference (p <0.05) in both groups. The mean scores of knowledge and self-care activities increased immediately after the interventions (p <0.05) and decreased two years later in both groups of the study. The descriptive analysis showed that the average self-efficacy score remained in the intervention group, and reduced in control, after two years at the end of the interventions. The results showed that the model of interventions, which included the family social support, showed no difference between groups over time, and through descriptive analysis, there was improvement of the self-efficacy, which remained after two years in the intervention group. The group educational interventions shown to be effective in improving glycemic control and blood pressure two years after the intervention, and for the variables knowledge about the disease and self-care activities, the results suggest the need for educational reinforcements over time

Zhang, Ji. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 100-104). / Abstracts in English and Chinese. / Chapter CHAPTER 1. --- Introduction / Chapter 1.1. --- Introduction of genetic association studies --- p.1 / Chapter 1.1.1. --- Application of genetic association studies in complex diseases --- p.3 / Chapter 1.1.2. --- Application of genetic association studies in type-2 diabetes --- p.4 / Chapter 1.2. --- Study design of genetic association studies --- p.7 / Chapter 1.3. --- Overview of statistical approaches in association studies --- p.10 / Chapter 1.3.1. --- Preliminary analyses --- p.10 / Chapter 1.3.1.1. --- HardýؤWeinberg equilibrium testing --- p.10 / Chapter 1.3.1.2. --- Inference of missing genotype data --- p.12 / Chapter 1.3.1.3. --- SNP tagging --- p.14 / Chapter 1.3.2. --- Single-point and multipoint tests for association --- p.15 / Chapter 1.4. --- Other relevant methods employed in this study --- p.20 / Chapter 1.4.1. --- Self-Organizing Maps (SOM) with further classification by K-means clustering --- p.20 / Chapter 1.4.2. --- Random forests --- p.27 / Chapter 1.5. --- Main objectives of this study --- p.31 / Chapter CHAPTER 2. --- Materials and methods / Chapter 2.1. --- Study cohort --- p.32 / Chapter 2.2. --- Study design --- p.34 / Chapter 2.2.1. --- Construction of sample sets for each stage using SOM and K-means clustering --- p.34 / Chapter 2.2.2. --- Stage 1 analysis by random forests --- p.37 / Chapter 2.2.3. --- Stage 2 analysis by chi-square test --- p.42 / Chapter 2.2.4. --- Two-stage genetic association study by chi-square test --- p.43 / Chapter 2.2.5. --- Comparison of results: random forests plus chi-square test versus chi-square test --- p.43 / Chapter 2.2.6. --- Validation of results in the whole sample set by allelic chi-square test --- p.44 / Chapter 2.2.7. --- Extensions of the study: cumulative effects of candidate SNPs on risk of type-2 diabetes --- p.45 / Chapter CHAPTER 3. --- Results / Chapter 3.1. --- Effects of sample classification by SOM and K-means clustering --- p.50 / Chapter 3.2. --- Genetic associations in stage 1 --- p.64 / Chapter 3.3. --- Genetic associations in stage 2 and validation of results --- p.69 / Chapter 3.4. --- Cumulative effects of candidate SNPs on risk of type-2 diabetes --- p.76 / Chapter CHAPTER 4. --- Discussion / Chapter 4.1. --- Overall strategy --- p.81 / Chapter 4.1.1. --- Effects of SOM and K-means clustering --- p.82 / Chapter 4.1.2. --- Effects of random forests in the first stage of association study --- p.83 / Chapter 4.1.3. --- Comparison of our method with traditional chi-square test --- p.84 / Chapter 4.1.4. --- Joint effects of candidate SNPs selected by the hybrid method --- p.86 / Chapter 4.2. --- Biological significance of candidate SNPs --- p.88 / Chapter 4.2.1. --- Gene CDKAL1 --- p.89 / Chapter 4.2.2. --- Gene KIAA1305 --- p.90 / Chapter 4.2.3. --- Gene DACH1 --- p.91 / Chapter 4.2.4. --- Gene FUCA1 --- p.92 / Chapter 4.2.5. --- Gene KCNQ1 --- p.93 / Chapter 4.2.6. --- Gene SLC27A1 --- p.94 / Chapter 4.3. --- Limits and improvement of this study --- p.96 / Chapter 4.4. --- Conclusion --- p.99 / REFERENCES --- p.100

Lui, Ming Yin. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 117-129). / Abstracts in English and Chinese. / Acknowledgement --- p.I / Abstract --- p.III / Abstract in Chinese --- p.V / List of Abbreviations --- p.VII / List of Figures --- p.X / List of Tables --- p.XII / Table of Contents --- p.XIII / Chapter Chapter 1: --- Introduction / Chapter 1.1 --- Overview on type 2 diabetes --- p.1 / Chapter 1.1.1 --- Definition of diabetes --- p.1 / Chapter 1.1.2 --- Diagnostic criteria --- p.2 / Chapter 1.1.3 --- Prevalence and societal impact --- p.2 / Chapter 1.1.4 --- Risks factors for type 2 diabetes --- p.4 / Chapter 1.1.4.1 --- Metabolic syndrome --- p.4 / Chapter 1.1.4.2 --- Genetics of type 2 diabetes --- p.6 / Chapter 1.1.4.3 --- "Environmental risk factors, lifestyle and energy imbalance" --- p.8 / Chapter 1.1.5 --- Pathophysiology of type 2 diabetes --- p.9 / Chapter 1.1.5.1 --- Insulin secretion and signaling --- p.9 / Chapter 1.1.5.1.1 --- Insulin Secretion --- p.9 / Chapter 1.1.5.1.2 --- Insulin signaling --- p.11 / Chapter 1.1.5.2 --- Natural history of type 2 diabetes --- p.12 / Chapter 1.1.5.3 --- Insulin resistance --- p.13 / Chapter 1.1.5.4 --- Impairment in insulin secretion --- p.15 / Chapter 1.1.5.5 --- Endocannabinoid system: A new target for energy balance and metabolism --- p.16 / Chapter 1.1.5.6 --- Effects of diabetes mellitus and its complications --- p.16 / Chapter 1.2 --- Biology of prostacyclin synthase (PTGIS) --- p.18 / Chapter 1.2.1 --- Molecular information of PTGIS --- p.18 / Chapter 1.2.2 --- Transcriptional control of PTGIS --- p.19 / Chapter 1.2.3 --- Protein structure of PGIS --- p.21 / Chapter 1.2.4 --- Sub-cellular localization and tissue distribution --- p.22 / Chapter 1.2.5 --- Function of PGIS --- p.25 / Chapter 1.2.5.1 --- Function of PGI2 in blood vessels --- p.26 / Chapter 1.2.5.2 --- Role of PGh in embryo development --- p.26 / Chapter 1.2.5.3 --- Role of PGI2 in apoptosis --- p.27 / Chapter 1.2.5.4 --- Targeted knock-out mice phenotype --- p.27 / Chapter 1.2.6 --- Relationship between PTGIS and diseases --- p.28 / Chapter 1.2.6.1 --- Genetic association --- p.28 / Chapter 1.2.6.2 --- Inactivation and tyrosine nitration of PGIS by peroxynitrite --- p.29 / Chapter 1.3 --- Biology of peroxisome proliferator-activated receptor delta (PPARD) --- p.30 / Chapter 1.3.1 --- Molecular information of PPARD --- p.30 / Chapter 1.3.2 --- Transcriptional control of PPARD --- p.31 / Chapter 1.3.3 --- Translational control and protein structure --- p.32 / Chapter 1.3.4 --- Sub-cellular localization and tissue expression --- p.35 / Chapter 1.3.5 --- Function of PPARδ --- p.37 / Chapter 1.3.5.1 --- Mechanisms of action --- p.37 / Chapter 1.3.5.2 --- Ligands for PPARδ --- p.38 / Chapter 1.3.5.3 --- PPARδ in lipoprotein metabolism --- p.39 / Chapter 1.3.5.4 --- PPARδ action in adipose tissue --- p.39 / Chapter 1.3.5.5 --- PPARδ action in skeletal and cardiac muscle --- p.40 / Chapter 1.3.5.6 --- PPARδ action in liver --- p.42 / Chapter 1.3.5.7 --- PPARδ and endocannabinoid system --- p.42 / Chapter 1.3.5.8 --- PPARδ action in inflammation --- p.43 / Chapter 1.3.5.9 --- Targeted knock-out mice phenotype --- p.44 / Chapter 1.3.5.10 --- Disease association --- p.44 / Chapter 1.4 --- Functional relationship of PGIS and PPARδ: possible role in energy metabolism --- p.46 / Chapter 1.5 --- Methods for studying genetics of type 2 diabetes and linkage analysis results --- p.47 / Chapter 1.5.1 --- Genome-wide scan --- p.47 / Chapter 1.5.2 --- Candidate gene approach --- p.48 / Chapter 1.6 --- Hypothesis and objectives --- p.49 / Chapter 1.7 --- Long-term significance --- p.49 / Chapter Chapter 2: --- Association Study of Prostacyclin Synthase and Peroxisome Proliferator-Activated Receptor Delta Gene Polymorphisms with Type2 Diabetes and Related Metabolic Traits / Chapter 2.1 --- Introduction and research design --- p.50 / Chapter 2.2 --- Study population --- p.52 / Chapter 2.2.1 --- Ethics approval --- p.52 / Chapter 2.2.2 --- Subjects --- p.52 / Chapter 2.2.3 --- Clinical assessments --- p.52 / Chapter 2.3 --- Materials and methods --- p.55 / Chapter 2.3.1 --- DNA samples --- p.55 / Chapter 2.3.2 --- Marker selection --- p.55 / Chapter 2.3.3 --- Genotyping --- p.57 / Chapter 2.3.4 --- Statistical analysis --- p.59 / Chapter 2.4 --- Results and Discussion --- p.60 / Chapter 2.4.1 --- Clinical characteristics of the study population --- p.60 / Chapter 2.4.2 --- Genotyping and LD analysis --- p.60 / Chapter 2.4.3 --- Association with type 2 diabetes and related metabolic traits --- p.61 / Chapter 2.4.3.1 --- Single SNP association with type 2 diabetes --- p.61 / Chapter 2.4.3.2 --- Single SNP association with metabolic traits --- p.64 / Chapter 2.4.3.3 --- Gene-gene interaction on type 2 diabetes --- p.74 / Chapter 2.4.3.4 --- Gene-gene interaction on metabolic traits --- p.74 / Chapter 2.5 --- Limitation and improvement --- p.79 / Chapter 2.6 --- Conclusions --- p.79 / Chapter Chapter 3: --- Functional Studies of Prostacyclin Synthase rs508757-A/G Intronic Polymorphism / Chapter 3.1 --- Introduction and research design --- p.80 / Chapter 3.2 --- Materials and methods --- p.81 / Chapter 3.2.1 --- Bioinformatics --- p.81 / Chapter 3.2.1.1 --- Cross-species alignment --- p.81 / Chapter 3.2.1.2 --- BLAST search and open reading frame prediction --- p.81 / Chapter 3.2.1.3 --- Transcription factor binding sites prediction --- p.82 / Chapter 3.2.2 --- PCR amplification from cDNA --- p.82 / Chapter 3.2.3 --- Culture of mammalian cell --- p.83 / Chapter 3.2.3.1 --- Cell line --- p.83 / Chapter 3.2.3.2 --- Medium and supplement --- p.83 / Chapter 3.2.3.3 --- Cell culture wares --- p.83 / Chapter 3.2.3.4 --- Cell culture conditions --- p.84 / Chapter 3.2.4 --- Construction of reporter vectors with rs508757 flanking sequence --- p.84 / Chapter 3.2.4.1 --- Cloning and vector preparation --- p.84 / Chapter 3.2.4.2 --- Site-directed mutagenesis --- p.84 / Chapter 3.2.5 --- Dual-luciferase reporter assay --- p.85 / Chapter 3.2.5.1 --- Transfection of VSMC --- p.85 / Chapter 3.2.5.2 --- Cell lysis and luminescence measurement --- p.86 / Chapter 3.2.6 --- Circular Dichroism --- p.87 / Chapter 3.2.6.1 --- Introduction to DNA quardruplex structure and circular dichroism --- p.87 / Chapter 3.2.6.1.1 --- DNA quardruplex --- p.87 / Chapter 3.2.6.1.2 --- Circular dichroism --- p.88 / Chapter 3.2.6.2 --- Circular dichroism measurement --- p.89 / Chapter 3.2.6.2.1 --- DNA samples --- p.89 / Chapter 3.2.6.2.2 --- CD spectroscopy --- p.89 / Chapter 3.2.7 --- Statistical analysis --- p.90 / Chapter 3.3 --- Results and Discussion --- p.91 / Chapter 3.3.1 --- Cross-species alignment --- p.91 / Chapter 3.3.2 --- BLAST search and ORF prediction --- p.92 / Chapter 3.3.3 --- PCR results on testing the presence of a new transcript --- p.93 / Chapter 3.3.4 --- Effect of rs508757 flanking sequence on SV40 promoter activity --- p.94 / Chapter 3.3.5 --- Circular dichroism experiment on rs508757 flanking sequence --- p.96 / Chapter 3.3.6 --- DNA slipping model --- p.98 / Chapter 3.3.7 --- Transcription factor binding site prediction --- p.99 / Chapter 3.4 --- Limitation and improvement --- p.107 / Chapter 3.5 --- Conclusions --- p.107 / Chapter Chapter 4: --- "General Discussion, Conclusion and Future Perspectives" / Chapter 4.1 --- General discussion --- p.108 / Chapter 4.2 --- Future perspectives --- p.115 / Chapter 4.2.1 --- "Association on type 2 diabetes and molecular interaction between transcription factors, PTGIS and PPARD" --- p.115 / Chapter 4.2.2 --- Association with diabetic nephropathy --- p.115 / Chapter 4.2.3 --- Study tissue or cell type specific actions of PGIS and PPARδ --- p.116 / Chapter 4.3 --- Conclusions to my project --- p.116 / Chapter Chapter 5: --- Bibliography --- p.117 / Appendix --- p.130

O objetivo deste trabalho foi comparar os efeitos sorológicos e clínicos de dois protocolos de terapias periodontais em indivíduos com diabetes tipo 2 (DMT2) e periodontite crônica. Foram analisados 36 pacientes, randomizados em dois grupos: um grupo recebeu terapia intensiva de raspagem e alisamento radicular (INT; n=18) e outro recebeu apenas raspagem supragengival (SUP; n=18). Os grupos foram avaliados quanto aos parâmetros clínicos periodontais e marcadores inflamatórios séricos, antes e após 6 meses do tratamento periodontal. O exame clínico periodontal avaliou: placa visível (IP), índice gengival (IG), supuração (SUPUR), profundidade clínica de sondagem (PCS) e nível clínico de inserção (NCI). Amostras sanguíneas foram obtidas para análise de marcadores inflamatórios e hemoglobina glicada (HbA1c). Os marcadores de inflamação avaliados foram: interleucina (IL)-1, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12, IL-13, IL-17, fator estimulador de colônias granulocitárias (G-CSF), fator estimulador de colônias de granulócitos-macrófagos (GM-CSF), interferon- (IFN-), proteína quimiotática de monócito-1 (MCP-1), proteína inflamatória de macrófago-1 (MIP-1) e fator de necrose tumoral (TNF-), através do imunoensaio multiplex (Bioplex). Ambas as terapias resultaram na melhora de quase todos os parâmetros clínicos periodontais (p<0,05), com exceção do NCI (p=0,09) no grupo SUP. Não houve diferença significativa para os níveis de IL-1, IL-4, IL-5, IL-10, IL-13, MIP-1 e TNF- (p>0,05), após tratamento, em ambas as terapias. Houve redução significativa de IL-6 (p=0,01), IL-12 (p=0,04) e MCP-1 (p=0,02) no grupo INT e de GCS-F nos grupos SUP (p=0,04) e INT (p=0,01). Os níveis de IL-2, IL-7, IL-8, IL-17, GM-CSF e IFN- não foram detectados. A terapia INT tem um efeito benéfico na redução dos níveis séricos de IL-6, IL-12 e MCP-1, na redução de PCS em sítios profundos e no ganho de inserção quando comparado à terapia supragengival em um período de 6 meses. / The objective of this study was to compare the serological and clinical effects of two periodontal therapies in individuals with type 2 diabetes (T2DM) and chronic periodontitis. 36 patients were analyzed, randomized into two groups: one group received intensive t of scaling and root planing (INT, n=18) and another received only supragingival scaling (SUP, n=18). The groups were evaluated for periodontal parameters and serum inflammatory markers before and after 6 months of periodontal treatment. The periodontal parameters assessed were: visible plaque (PI), gingival index (GI), suppuration (SUP), probing pocket depth (PPD) and clinical attachment level (CAL). Blood samples were obtained for analysis of inflammatory markers and glycated hemoglobin (HbA1c). The inflammatory markers evaluated were: interleukin (IL)- 1 , IL- 2, IL -4, IL -5, IL -6, IL -7 , IL-8 , IL-10 , IL-12 , IL-13 , IL -17, granulocyte colony-stimulated factor (G -CSF), colony stimulating factor granulocyte-macrophage (GM -CSF), interferon - (IFN - ), monocyte chemotactic protein-1 (MCP-1) , macrophage inflammatory protein-1 (MIP-1 ) and tumor necrosis factor (TNF- ) through a multiplex immunoassay (Bioplex). Both therapies resulted in improvement of almost all periodontal clinical parameters (p<0.05), with the exception of the NCI in SUP group. There was no significant difference for (IL )- 1 , IL- 4, IL -5, IL-10 , IL-13 , MIP- 1 and TNF- after treatment for both therapies (p>0.05). A significant reduction was observed in IL-6 (p=0.01), IL-12 (p=0.04) and MCP-1 (p=0.02) levels for INT group and in GCS- F levels for SUP (p=0.04) and INT (p=0.01) groups. The levels of IL-2, IL -7, IL-8 , IL-17, GM- CSF and IFN- were not detectable. The INT therapy has a beneficial effect in reducing serum levels of IL-6, IL-12 and MCP-1, in reducing PPD of deep sites and in attachment gain when compared to SUP therapy considering a period of 6 months.

INTRODUÇÃO: A obesidade é uma doença crônica que tem se tornado um dos maiores problemas de saúde das últimas décadas. A etiologia da obesidade é multifatorial, o que dificulta seu tratamento. O balão intragástrico (BIG) constitui um método pouco invasivo, reversível, de curto prazo para a perda de peso, além de auxiliar na mudança de hábitos alimentares e comportamentais. Promove distensão gástrica, acarretando na diminuição da ingestão alimentar, atrasa o esvaziamento gástrico e causa sensação de saciedade. O objetivo deste trabalho foi avaliar os efeitos do BIG em pacientes com diabetes mellitus tipo 2 (DM2) e sobrepeso ou obesidade grau I, através da análise da perda de peso, composição corporal, metabolismos glicêmico e lipídico, produção de enterohormônios e qualidade de vida. MÉTODOS: realizou-se ensaio clínico, incluindo 40 pacientes com DM2 e (IMC de 27 a 34,9 kg/m2), os quais foram submetidos à colocação do BIG, mantido por 6 meses, e com seguimento por mais 6 meses após sua retirada. Um teste de refeição com dieta padronizada foi realizado nos tempos 0 e 6 meses, com dosagens de glicose, insulina, triglicérides, GLP-1 ativo e PYY total nos tempos 0, 30, 60, 120 e 180 minutos. RESULTADOS: O peso absoluto diminuiu em 15,6 +- 7,23 kg após 6 meses do uso do BIG, o que corresponde à perda de 17,1% do peso total. Após os 6 meses de seguimento, a média de perda de peso foi mantida em 13,89 kg (15,2%). Houve redução significativa na massa de gordura corporal e da área da curva de glicose, insulina e triglicérides (p variou de < 0,001 a 0,003). Dos 24 pacientes (60%) portadores de hipertensão arterial sistêmica no início do estudo, apenas 3 (7,5%) mantiveram-se hipertensos após o uso do BIG. Os níveis séricos de GLP-1 ativo e PYY total diminuíram com o uso do BIG. A qualidade de vida melhorou em todos os domínios analisados (p < 0,001 a 0,041): capacidade funcional, aspectos físicos, dor, estado geral de saúde, vitalidade, aspectos sociais, aspectos emocionais e saúde mental. CONCLUSÃO: o BIG foi eficaz para perda de peso e controle do DM2 com melhora na qualidade de vida. Não há correlação positiva com a produção de enterohormônios / INTRODUCTION: Obesity is a chronic disease that has become one of the biggest health problems on the last decades. The etiology of obesity is multifactorial, which makes the success of treatment more difficult. Intragastric balloon (BIB) is a short term, reversible, minimally invasive method for weight loss. Furthermore, it helps changing eating habits and behavior. It promotes gastric distension, resulting in decreased intake of food, potentially delays gastric emptying and enhances the feeling of satiety. The objective of this study was to evaluate the effects of BIB in patients with type 2 diabetes mellitus (T2DM) and overweight or with grade I obesity, by analyzing the weight loss, body composition, glucose and lipid metabolism, production of enterohormones and quality of life. METHODS: Clinical trial including 40 patients with T2DM and BMI 27-34.9 kg/m2, which underwent placement of BIB, kept for 6 months, and follow-up for another 6 months after withdrawn. A standardized meal test diet was carried out at 0 and 6 months. Glucose, insulin, triglycerides, GLP-1 active and total PYY were measured at times 0, 30, 60, 120 and 180 minutes. RESULTS: The total weight decreased by 15.6 +- 7.23 kg after 6 months of use of BIB, which corresponds to loss of 17.1% of the total weight. After 6 months of follow-up, mean weight loss was maintained at 13.89 kg (15.2%). There was a significant reduction in body fat mass and area of the glucose curve, insulin and triglycerides (p ranged from < 0.001 to 0.003). Of the 24 patients (60%) patients with hypertension at baseline, only 3 (7.5%) remained hypertensive after using the BIB. Serum levels of active GLP-1 and total PYY decreased with BIB. The quality of life improved in all domains analyzed (p < 0.001 to 0.041): physical functioning, physical function, pain, general health, vitality, social functioning, emotional aspects and mental health. CONCLUSION: BIB is effective for weight loss and control of DM2 with quality of life improvement. There is no positive correlation with the production of enterohormones

Introdução: Os mecanismos responsáveis pela evolução do diabetes associado à obesidade entre pacientes bariátricos são alvos de muitos estudos atualmente. As principais linhas de pensamento envolvem alterações no índice de massa corporal (IMC), hormônios gastrointestinais, inflamação sistêmica e a reformatação ou reeducação alimentar. A maioria destes quesitos foi examinada sob a ótica do curto prazo, sendo que informações concernentes a casos com 10 anos de pós-operatório ainda são escassos. Objetivos: Avaliar o desfecho da homeostase glicídica tardio após a DGYR, em pacientes com e sem diabetes prévio, e documentar os parâmetros clínicos e nutricionais que diferenciem estes grupos. Metodologia: Estudo observacional controlado retrospectivo e prospectivo de 100 pacientes submetidos à derivação gástrica em Y de Roux. Estes pacientes foram divididos em dois grupos iniciais, um com diabetes no pré-operatório e outro sem diabetes. Em seguida, os dois foram subdivididos em quatro subgrupos conforme a evolução do diabetes, sendo eles refratário, responsivo, estáveis e não estáveis, respectivamente. Dados demográficos, laboratoriais, nutricionais, prescrições medicamentosas e evolução clínica do diabetes no pós-operatório a longo prazo foram coletados. Resultados: Dos 96 pacientes efetivamente avaliados, a idade situou-se em 50,39 (± 10,98) no grupo refratário, 56,63 (± 8,29) no grupo responsivo, 47,62 (± 10,72) no grupo estável e 48,17 (± 10,45) no grupo não estável. O sexo feminino prevaleceu em todos os grupos. Uma taxa de 66,7% dos pacientes com diabetes alcançaram a remissão da doença após a DGYR, o tempo de diagnóstico de diabetes pré-operatório se relacionou com o grupo refratário, e uma população de novos diabéticos se configurou tardiamente em pacientes sem a doença no período pré-operatório. Conclusão: 1) A derivação gástrica em Y de Roux induziu remissão em 66,7% dos pacientes com diabetes prévio; 2) O tempo de diagnóstico de diabetes tipo 2 esteve associado com ausência da resposta cirúrgica; 3) Pacientes euglicêmicos desenvolveram diabetes após a intervenção na proporção de 17,7%, comprovando que a proteção do procedimento bariátrico contra a instalação do diabetes tipo 2 se atenua com o passar dos anos; 4) Tanto os pacientes com a glicemia anormal quanto os euglicêmicos submetidos à DGYR, necessitam de um seguimento a longo prazo do homeostase glicídica / Introduction: The mechanisms responsible for the development of diabetes associated with obesity among bariatric patients are targets of many ongoing studies. The main lines of thought involve changes in body mass index (BMI), gastrointestinal hormones, systemic inflammation and reformatting nutritional education. Most of these issues were examined from a short term perspective, with information concerning cases after 10 years still scarce. Objectives: Evaluate the outcome of long term of glucose homeostasis after DGYR in patients with and without previous diabetes, and document the clinical and nutritional parameters that differentiate these groups. Methods: An observational retrospective and prospective controlled study with 100 patients undergoing Roux-en-Y gastric bypass. These patients were divided into two initial groups, one with diabetes preoperatively and another without. Then the two groups were subdivided into four subgroups according to the evolution of diabetes, namely refractory, responsive, stable and unstable respectively. Demographic, laboratory, nutritional, and clinical information along with drug prescriptions were collected Results: Among the 96 patients effectively studied, age was 50.39 (± 10.98) in the refractory group, 56.63 (± 8.29) in the responsive group, 47.62 (± 10.72) in the stable group and 48 , 17 (± 10.45) in the unstable group. Females were the majority in all groups. About 66,7% of patients with diabetes achieved disease remission after DGYR, and duration of diabetes was associated with the refractory group. A population of new-onset diabetes was identified in patients without disease in the preoperative period. Conclusion: 1) Roux-en-Y gastric bypass induced remission in 66,7% of patients with previous diabetes; 2) Duration of diagnosis of type 2 diabetes was associated with surgical response, 3) Euglycemic patients developed diabetes after the intervention in the proportion of 17,7%, proving that the protection of bariatric procedure against type 2 diabetes is attenuated over the years; 4) Both patients with abnormal glucose profile as well as those euglycemic undergoing DGYR, require long follow-up of glucose homeostasis

<p>Self care is very important for patients with diabetes type 2, as it can reduce complications. A proper and functioning self-care requires, clear and relevant information and instructions from the health care givers. <strong>Aim:</strong> The purpose of this study was to investigate the self care activities of patients with diabetes mellitus type 2 in Ho Chi Minh City and compare these between genders. <strong>Research questions: </strong>How do patients with diabetes mellitus type 2, in Ho Chi Minh City, practice self care activities (diet, exercise, blood sugar test, foot care, smoking, medication and self-care recommendation)?<strong> </strong>Are there any differences between genders concerning these self-care activities? <strong>Method: </strong>A descriptive and comparative cross-section design with a quantitative method was used. Dorothea Orem's theoretical framework was also used. The data was collected at the Department of Endocrinology and the Endocrinology Clinic, Choray hospital, in Ho Chi Minh City, Vietnam. It was 100 participants who answered a questionnaire about their diabetes self-care activities. <strong>Results: </strong>Most of the participants had a good self-care of their diabetes type 2. A majority of the participants had got several self-care recommendations from their health-care givers concerning diet, exercise, medication and blood-glucose control. It was a significant difference between gender in favour for the male gender concerning the statements high fat food, participating in 30 minutes of exercise, check inside the shoes, dry between toes, counselling about stop smoking, tried herbal medicine as medication.<strong> </strong><strong>Conclusion: </strong>The diabetes type 2 patients in Ho Chi Minh City need to get more information about self-care concerning blood-glucose, diet and exercise. Both genders need to adopt a healthy lifestyle into their daily life to reduce the risk of developing diabetes complications.</p> / <p>Egenvården är mycket viktig för patienter med diabetes typ 2, eftersom den kan minska komplikationer. En optimal och väl fungerande egenvård kräver tydlig och relevant information och instruktioner från vårdpersonalen. <strong>Syfte:</strong> Syftet med denna studie är att undersöka egenvårdsaktiviteter hos patienter med diabetes mellitus typ 2 i Ho Chi Minh City och jämföra dessa mellan kön. <strong>Frågeställningar:</strong> Hur utför patienter med diabetes mellitus typ 2 i Ho Chi Minh City sina egenvårds aktiviteter (kost, motion, blodsocker test, fotvård, rökning, läkemedel och egenvårds rekommendationer)? Finns det någon skillnad mellan könen beträffande dessa egenvårdsaktiviteter? <strong>Metod:</strong> En beskrivande och jämförande tvärsnitts studie med kvantitativ metod har använts. Dorothea Orems egenvårdsteori har även använts. Data samlades in vid Institutionen för Endokrinologi och endokrinologi kliniken på Choray hospital, i Ho Chi Minh City, Vietnam. Det var 100 deltagare som besvarade ett frågeformulär med frågor om diabetes egenvårds aktiviteter. <strong>Resultat:</strong> De flesta deltagare hade en god egenvård av sin diabetes typ 2. En majoritet av deltagarna hade fått flera egenvårds rekommendationer från sin vårdgivare om kost, motion och medicinering. Det var en signifikant skillnad mellan könen med fördel för männen angående påståendena gällande fettrik mat, deltagande i 30 minuters träning, kontrollera insidan av skorna, torka mellan tårna, rådgivning om att sluta röka samt provat naturläkemedel som medicinering. <strong>Slutsats</strong>: Diabetes typ 2 patienter i Ho Chi Minh City behöver få mer information om egenvård av blodglukos, mat och fysisk träning. Båda könen behöver få en hälsosammare livsstil i sin vardag för att minska risken för komplikationer.</p>

Bakgrund: Diabetes mellitus typ 2 innebär att glukoshalten i blodet inte kan regleras korrekt. Sjukdomen behandlas både medicinskt och med livsstilsförändringar. Antalet insjuknade ökar stadigt i världen och många miljoner människor lever idag med sjukdomen. Syfte: Syftet var att beskriva hur personer med diabetes mellitus typ 2 upplever livet. Metod: En litteraturöversikt med induktiv ansats valdes. Tio artiklar med kvalitativ metod användes i resultatet. Analys skedde med hjälp av Fribergs 5-stegs modell där artiklarnas resultat lästes flera gånger och gemensamma resultat plockades ut och kategoriserades. Resultat: Fyra teman identifierades där resultatet visade att personer diagnostiserade med diabetes mellitus typ 2 upplevde oro och ångest. Personerna kände även krav på att förändra sin livsstil, främst gällande kost och motion. De upplevde att tillvaron kastades omkull och att det tog lång tid att få tillbaka kontrollen. Personerna kände också att sjukdomen gjorde att omgivningen såg annorlunda på dem och att deras personlighet påverkade hanteringen av sjukdomen. Slutsatser: En psykosocial påverkan upplevdes efter diagnostisering med diabetes mellitus typ 2. Nödvändiga anpassningar av kost och motion påverkade relationer och identitet. Sjuksköterskan spelade en viktig roll i personens egenvård där professionellt bemötande stärkte autonomi och livskvalitet. Familj, vänner och religion påverkade också förutsättningarna att hantera situationen. / Background: Diabetes mellitus type 2 means that the glucose levels in the blood are not correctly regulated. The condition is treated both medically and with lifestyle changes. The number of persons with diabetes mellitus type 2 is steadily increasing in the world today and millions of people worldwide are living with the condition. Aim: The aim was to describe how people with diabetes mellitus type 2 experienced life. Method: A literature review with inductive onset was chosen. Ten qualitative articles were used in the result. Analysis was done using Friberg’s 5-step model where the results of the articles were read several times and common results were picked out and categorized. Result: Four themes were identified and the result showed that people diagnosed with diabetes mellitus type 2 experienced worry and anxiety. They also felt the difficulty and pressure of lifestyle changing demands regarding diet and exercise. They experienced an overwhelming change in their lives that took a long time for them to regain control. In addition, they felt that the entourage viewed them differently and that their personality affected the management of the condition. Conclusion: A major psychosocial impact was experienced after being diagnosed with diabetes mellitus type 2. Necessary adjustments related to diet and exercise had an impact on relationships and identity. The nurse played an important role in the person’s self-management and a professional treatment strengthened the person’s autonomy and quality of life. Family, friends and religion had an impact on the ability to handle the situation.

Diabetes mellitus typ 2 kännetecknas av förhöjd plasmaglukos och normalisering av glukosnivån kräver av patienten följsamhet till behandlingen som består av  livsstilsförändringar och farmakologisk behandling. Kontinuerligt stöd för god egenvård krävs för att minska riskerna för komplikationer. Många når inte behandlingsmålen trots bättre  behandlingsmetoder och patienter uppger att de inte får det stödet de önskar. Studiens syfte var att belysa patientupplevelser från besöken inom diabetesvården. Studien gjordes i form av litteraturstudie med avsikt att undersöka aktuell forskning inom diabetesvården. Patienter värdesatte individuellt bemötande. Relationen mellan patienten och vårdgivaren påverkades negativt om patienten inte fick delta i konsultationen. Generell, inadekvat information kunde minska patientens motivation till egenvården. Språkbarriär och vårdgivarens bristande kulturella kompetens kunde försämra migranternas behandling. Patienter värdesatte vårdgivarens samförstånd med dem. Inadekvat information och distanserat bemötandeeller brist på delaktighet i möten upplevdes negativt för vårdrelationen. Ömsesidighet i informationsöverföringen och relationen underlättade kommunikationen. Pedagogisk utbildning till fler vårdgivare skulle genom bättre samtalsfärdigheter höja kvaliteten i patientutbildningen. Stöd till beteendeförändring, baserat på kognitiv beteendeterapi, väntar på att implementeras. Personer med diabetes mellitus typ 2 behöver mer tid för egenvårdsutbildning. Ny forskning kan riktas mot individuella konsultationer, som inte är lika mycket undersökta som gruppundervisning angående behandlingsresultat. / Diabetes is characterized by hyperglycaemia. The patients have to change their lifestyle and follow their medical treatment because it is important with normal glucose level. Patients need continuous support and encouragement because of the chronic illness. The goal is to have a good self-management to decrease the risks of complications. Many patients don’t reach the goals for glucose levels although better treatments exist today and they express their dissatisfaction with their treatment. The aim of this study was to elucidate the patient experiences from their visits in the diabetic care. Literature study was chosen to examine the latest research. The patients value meeting the caregivers as individuals. If the patient was not allowed to participate the consultation, they felt the relationship to the caregiver as being negative. General, inadequate information could decrease the patient´s motivation to self-management. Language barrier, the caregivers lacking cultural competence and lacking cultural sensitivity could worsen the migrants´ treatment. Mutual information exchange, acknowledgement on the caregiver´s understanding on the patient´s situation and mutual problem solving were the founding elements in a successful communication. The caregivers approach could traditionally be authoritarian and the patient´s participation during consultations was missing at times, partially or entirely. Several caregivers could be offered pedagogical education to increase the care quality. A new intervention, support for behavioral change based on cognitive therapy, have developed and await implementation. Patients with diabetes mellitus type 2 needs more time by the visits for their education and support for their life long illness. New studies needs for examine results of the individual consultations and treatment goals, it has been done more studies about group education for diabetic patients until now.

Self care is very important for patients with diabetes type 2, as it can reduce complications. A proper and functioning self-care requires, clear and relevant information and instructions from the health care givers. Aim: The purpose of this study was to investigate the self care activities of patients with diabetes mellitus type 2 in Ho Chi Minh City and compare these between genders. Research questions: How do patients with diabetes mellitus type 2, in Ho Chi Minh City, practice self care activities (diet, exercise, blood sugar test, foot care, smoking, medication and self-care recommendation)? Are there any differences between genders concerning these self-care activities? Method: A descriptive and comparative cross-section design with a quantitative method was used. Dorothea Orem's theoretical framework was also used. The data was collected at the Department of Endocrinology and the Endocrinology Clinic, Choray hospital, in Ho Chi Minh City, Vietnam. It was 100 participants who answered a questionnaire about their diabetes self-care activities. Results: Most of the participants had a good self-care of their diabetes type 2. A majority of the participants had got several self-care recommendations from their health-care givers concerning diet, exercise, medication and blood-glucose control. It was a significant difference between gender in favour for the male gender concerning the statements high fat food, participating in 30 minutes of exercise, check inside the shoes, dry between toes, counselling about stop smoking, tried herbal medicine as medication. Conclusion: The diabetes type 2 patients in Ho Chi Minh City need to get more information about self-care concerning blood-glucose, diet and exercise. Both genders need to adopt a healthy lifestyle into their daily life to reduce the risk of developing diabetes complications. / Egenvården är mycket viktig för patienter med diabetes typ 2, eftersom den kan minska komplikationer. En optimal och väl fungerande egenvård kräver tydlig och relevant information och instruktioner från vårdpersonalen. Syfte: Syftet med denna studie är att undersöka egenvårdsaktiviteter hos patienter med diabetes mellitus typ 2 i Ho Chi Minh City och jämföra dessa mellan kön. Frågeställningar: Hur utför patienter med diabetes mellitus typ 2 i Ho Chi Minh City sina egenvårds aktiviteter (kost, motion, blodsocker test, fotvård, rökning, läkemedel och egenvårds rekommendationer)? Finns det någon skillnad mellan könen beträffande dessa egenvårdsaktiviteter? Metod: En beskrivande och jämförande tvärsnitts studie med kvantitativ metod har använts. Dorothea Orems egenvårdsteori har även använts. Data samlades in vid Institutionen för Endokrinologi och endokrinologi kliniken på Choray hospital, i Ho Chi Minh City, Vietnam. Det var 100 deltagare som besvarade ett frågeformulär med frågor om diabetes egenvårds aktiviteter. Resultat: De flesta deltagare hade en god egenvård av sin diabetes typ 2. En majoritet av deltagarna hade fått flera egenvårds rekommendationer från sin vårdgivare om kost, motion och medicinering. Det var en signifikant skillnad mellan könen med fördel för männen angående påståendena gällande fettrik mat, deltagande i 30 minuters träning, kontrollera insidan av skorna, torka mellan tårna, rådgivning om att sluta röka samt provat naturläkemedel som medicinering. Slutsats: Diabetes typ 2 patienter i Ho Chi Minh City behöver få mer information om egenvård av blodglukos, mat och fysisk träning. Båda könen behöver få en hälsosammare livsstil i sin vardag för att minska risken för komplikationer.